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S - H127243 <br /> { <br /> LAWRENCE LIVERMOVIVE NATIONAL LABORATORY -01 <br /> HAZARDOUS WASTE DISPOSAL REQUISITION HWM Use Only Page , of 1 <br /> 1.Building No: 2. Room No: 3. RMMA: 10.Hazardous k? fthoduletwasta to: Vold Requisition <br /> 2-7 ❑ Yes CK No Properties : <br /> �]ToxicMot"', ❑DATE: <br /> 4.WAA No: 5.Workplace End Date: 6.Account No: 12,Outer Container 13.Outer Container Size: InitialslDate <br /> (� �/i / C _ 7 r - ❑Corrosive Type: ❑ 1 gal ❑330 gal HSM` RO'R <br /> ❑ Ignitable ❑ 5 al ❑660 al [:j <br /> OffhlY&is111L �� � <br /> 7.Waste Minimization Efforts Practiced During Generation of this Waste? ZNo g Box ❑ 9 9 <br /> ❑ Reactive Can r-11:17507 gal 750 gal Shl <br /> ❑ W <br /> Yes, Activity Codes(enter up to four): W W W 30 gal ❑1000 galPMO WTO <br /> ❑ <br /> Comments: <br /> 11.Waste Form: EJ Carboy ❑55 ga ❑5000 gal 1711 <br /> Carbo r <br /> l <br /> (,Solid El Drum E3 85 al ❑1xlx1.5 ft <br /> Did this Waste Minimization effort begin in current calendar year? ❑Yes Z No El Liquid El Tank-Fixed g ❑2x4x7 it ❑HWM�leid pump Ouf <br /> ❑ ❑ . <br /> 8.Profile No: 9.Directorate: ❑ F-1Tank-Portable 4x4x7 ft <br /> Sludge ° 71gal HWM Genera <br /> C . M ❑Gas )(other. AJd Otherowax H Z El cu ft ❑5ew®C: DATE:1_l RSDfi#: <br /> H P ---- --- <br /> 14.ITEM 15.AQUEOUS ONLY 16.ANALYSIS 17.SOURCE 18.CHEMICAL/PHYSICAL DESCRIPTION 19.QUANTITY <br /> NO. * SAMPLE NO. CODE per item <br /> H Normality* Amount Units <br /> COMPLET <br /> SEP 101993 <br /> For RMMA Waste *Normality Required if pH s 2 or pH z 12.5 US C TION FORM FOR ADDITIONAL ITEMS <br /> 20.Was the waste kept isolated from B I <br /> any operation that could have 22.Describe other controls used to prevent radioactive contamination: <br /> 14 sag <br /> produced radioactive contamination 23.1 certify,to the best of my knowledge,that the information provided on this requisition is correct.I understand that I may be Iia a to ante and Federal prosecution by intentionally <br /> (using a glove box,vent hood,etc.)? providing false information. <br /> Yes❑ No❑ <br /> (if no,full rad analysis required) Generator Name(Print-Last,First): L-Code: Ext.: Inspected by HWM(Print Name-Last,First): Ext.: <br /> 21.Was the waste exposed to part icle �� / �. y 3 <br /> beams capable of inducing radioactivity Signature: Employee No.: Date: Sighatute° Employee No.: Date: <br /> by activation? Yes❑ No❑ / <br /> (If yes,full rad analysis required) <br /> ITEM P <br /> Prefix <br /> RCH P Origin Form EPA NO. DTSC NO. MSDS NO. +Hazardous Properties Handling Code: By: <br /> Code Code <br /> T C I R <br /> Date: Loc: <br /> v 5-/) -1 1 931 � EJ F-10 El <br /> ❑ ❑ ❑ ❑ Chemical Compatibility Code: <br /> Department Generating Waste: <br /> El El ❑ ❑ <br /> �" ba aL D <br /> F-1 E-1 ❑ ❑ H Requisiti A p L(Si nature) <br /> F-10 ❑ ❑ 1 Date: C— <br /> LL 5344-B(Rev.3'93) 7600-70302 <br /> White—HWM Copy <br />